What got me started?
I was introduced to the Neurodevelopmental Treatment (NDT) approach in 2006, when I was looking for neuropediatric knowledge that would give me a stronger foundation as a therapist to understand children with special needs. At that time, I had already worked in a pediatric clinic where I had the opportunity to treat children with various diagnoses. This experience gave me an overview of what my role would be as a physical therapist. I really wanted to cultivate my skills and develop my practice in order to provide each child and family with the best care possible.
An understanding of the very basis of analyzing atypical and typical posture and movement, and as a therapist, a starting point for identifying where the child has movement difficulties.
Therapeutic manipulation and my ability to use my voice, body movements and hands to influence the child’s movement.
A clinical decision-making framework, to set goals that are child and family centered, taking into account the child’s contextual factors and environment.
NDT Beliefs and Perspective
NDT is a holistic, interdisciplinary clinical practice model based on current and evolving research, which emphasizes individualized therapeutic treatment based on movement analysis for the rehabilitation of children with neurological Dubai pathophysiology.
The therapist uses the International Classification of Functioning, Disability and Health (ICF) model in a problem-solving approach to assess activity and participation, thereby identifying and prioritizing relevant integrities and impairments as a basis for establishing actionable outcomes with clients and caregivers.
The foundation for NDT examination, assessment and intervention is formed by a thorough knowledge of the human movement system, including understanding of typical and atypical development, and expertise in the analysis of postural control, movement, activity and participation across the lifespan.
Therapeutic manipulation used in assessment and intervention consists of a reciprocal dynamic interaction between the child and therapist, aimed at activating optimal sensorimotor processing, task performance, and skill acquisition to enable participation in real life environments and meaningful activities.
Doing what works
TND provides me with a starting point in observing the child, to understand the how and why of movement dysfunction.
As Mary Quinton rightly said, “First train the outer eye to observe and record, then look with the inner eye to analyze the likely causes of what the outer eye sees.”
CND is a child-centered approach that emphasizes working with the strengths of the child as an individual.
For example, a 3-year-old with athetoid cerebral palsy who is unable to speak, but has created and uses an informal “sign language” that his family understands, is quite capable of meeting his basic needs at home.
We focus on effective and ineffective posture and movement strategies and identify compensatory strategies used by the child during function. This involves assessing the child’s misalignments and compensations in an area that directly affects their movement and overall functional ability.
For example, a child with cerebral palsy develops a W-shaped sitting pattern to avoid using the core muscles of the trunk, resulting in tibial torsion changes with bony changes also at the hip joint.
Impairments are treated in the context of the child’s goal in a functional setting.
For example, a child with hemiplegia must use the less involved side to support himself when he stands up to stand; he cannot stand up to stand holding an object in his hand.
Handling encompasses therapeutic use of auditory input, visual input, movement of therapist’s body as well as hands on information.
For example, a Physical therapist would wonder, “Can little K get up to standing from her chair with less effort if I assist her weight shift forward? Or if I give her the feeling of pushing into the support, can she then do it without my assistance? Or will baby increase the amount of time reaching with outstretched arms with an audio-visual stimulation from a toy? Or if I provide proximal stabilization at her shoulders?
Intervention is designed to obtain active responses from the child in goal directed activities.
For example, M will get up from bench sitting to standing whilst holding on the grab bars of walker with verbal prompts. Or M will push her pants down from her hips, once started and seat herself on a regular toilet using a small step.
Active feed-forward movements guided by the therapist’s facilitation are effective in obtaining the desired outcomes for children who cannot participate in cognitively directed movements.
This approach provides a comprehensive understanding of the children we work with and helps me to collaborate with my OT and SLT colleagues to treat the child as an individual.
For example, in children with Cerebral palsy, the ribcage often remains elevated and spine rounded. This affects the mobility of the ribcage needed during movement and speech. Immobility of the laryngeal areas develops due to low tone or increased muscle tone and failure to develop an upright posture against gravity.
It is an approach that has evolved over a period of many years and continues to shift our paradigm in thinking.
What does the Future hold for NDT?
Technological advances in neurorehabilitation, such as robotics, exoskeletal systems, combined with the current techno-savvy generation do present cause of concern regarding the expectation of our future therapists and consequently the future and survival of this hands-on approach.
We are hopeful that as robotics become less expensive, therapists will see these means of providing additional practice opportunities for patients outside of therapy sessions rather than a replacement for valuable, skilled, quality one-to-one therapist to patient intervention.
Could technology provide us with more sophisticated measures of change in alignment, muscle activation, quality, and efficacy of movement, which are all hallmarks of NDT intervention but difficult to measure with any of our current standardized outcome measures?